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Hypotonic infant (Aetiology (Infection CNS: CMV, toxoplasmosis, rubella …
Hypotonic infant
Aetiology
Infection
CNS: CMV, toxoplasmosis, rubella
PNS: botulism
Trauma
Spinal cord: birth trauma
Vascular
CNS: haemorrhage, ischemia
Autoimmune
NMJ: myasthenia gravis
Congenital/genetic
CNS: Down's syndrome
PNS: SMA, HMSNs, MD, DM
Degenerative
CNS: syringomyelia
Diagnosis
Examination
Neonatal exam
Poor truncal tone, head lag
Dysmorphic features
Frog-like posture
Reduced tendon reflexes
Investigations
Bloods
FBC (infection), CRP, U+E, LFTs
Autoimmune screen (MG)
Infection screen (rubella, CMV, toxoplasmosis)
genetic tests (Down's, SMA, HMSNs, MD, DM)
Imaging
CT/MRI head (haemorrhage, ischemia,
structural defects)
MRI spine (trauma, syringomyelia)
Bedside
Obs (infection)
History
PMH
Known conditions
DH
Current meds
POH
Scans, bloods, growth,
gestation, delivery, weight, complications
FH
Neurological/genetic conditions
PC/HPC
Floppy baby at birth
SH
Living arrangements,
parental smoking/alcohol/drug status
Pathophysiology
Central
(poor truncal tone)
Brain
Vascular: Haemorrhage, ischemia
Infection: congenital infection e.g. CMV, rubella
Genetic conditions e.g. Down's syndrome
Drugs. e.g. benzos
Spinal cord
Trauma: birth trauma e.g. Breech
Degenerative: syringomyelia
Peripheral
(poor limb tone)
Peripheral nerve
Congenital/genetic: HMSNs
NMJ
Infection: botulism
Autoimmune: myasthenia gravis
Anterior horn
Congenital/genetic: SMA
Muscle
Congenital/genetic: muscular dystrophies (DMD, BMD),
dystrophica myotonica
Clinical
presentation
Floppy baby
Head lag
Definition
Neonate presenting
with reduced muscle tone
Management
Per cause